Practice Variation With Febrile Infants: Delight in Disorder?

Abstract

A careless shoe-string, in whose tie I see a wild civility: Do more bewitch me, than when art Is too precise in every part. “Delight in Disorder,” Robert Herrick (1591–1674) Herrick's 17th-century sonnet seems the antithesis of the scientific movement toward evidence-based medicine. And, of course, it mostly is: there is no place for the “careless” or the “wild.” Yet those of us who still exalt in the “art” of medicine are less “bewitched” when guidance becomes “too precise in every part.” This is a subversive sentiment and, if applied to our patients, must be done so thoughtfully and responsibly. However, it may lead us to a useful insight: evidence-based medicine is not incompatible with significant practice variation. In this month's issue of Pediatrics , Goldman et al1 describe (with a perceptible sense of dismay) practice variation across Canadian pediatric emergency departments in the management of febrile infants younger than 90 days. Although most infants had blood and urine work performed, the authors are particularly struck by the variability in lumbar puncture rates. They imply that such variability is hard to justify … Address correspondence to Louis C. Hampers, MD, MBA, University of Colorado School of Medicine, Section of Pediatric Emergency Medicine, 13123 E 16th Ave, B251, Aurora, CO 80045. E-mail: hampers.lou{at}tchden.org